Long-term mortality and health-related quality of life with lower versus higher oxygenation targets in intensive care unit patients with COVID-19 and severe hypoxaemia

• Published in: Intensive care medicine 2024-10, Vol.50 (10), p.1603-1613
• Main Authors: Crescioli, Elena, Nielsen, Frederik Mølgaard, Bunzel, Anne-Marie, Eriksen, Anne Sofie Broberg, Siegemund, Martin, Poulsen, Lone Musaeus, Andreasen, Anne Sofie, Bestle, Morten Heiberg, Iversen, Susanne Andi, Brøchner, Anne Craveiro, Grøfte, Thorbjørn, Hildebrandt, Thomas, Laake, Jon Henrik, Kjær, Maj-Brit Nørregaard, Lange, Theis, Perner, Anders, Klitgaard, Thomas Lass, Schjørring, Olav Lilleholt, Rasmussen, Bodil Steen
• Format: Article
• Language: English
• Subjects: Aged; Anesthesiology; Blood pressure; Confidence intervals; Coronaviruses; COVID-19; COVID-19 - complications; COVID-19 - mortality; COVID-19 - therapy; Critical Care Medicine; Emergency Medicine; Female; Humans; Hypoxia - mortality; Intensive; Intensive care; Intensive Care Units - statistics & numerical data; Male; Medicine; Medicine & Public Health; Middle Aged; Mortality; NCT NCT; NCT04425031; Original; Oxygen - blood; Oxygen Inhalation Therapy - methods; Oxygenation; Pain Medicine; Partial pressure; Pediatrics; Pneumology/Respiratory System; Quality of Life; SARS-CoV-2; Viral diseases
• ISSN: 0342-4642; 1432-1238; 1432-1238
• DOI: 10.1007/s00134-024-07613-2

Purpose The aim of this study was to evaluate one-year outcomes of lower versus higher oxygenation targets in intensive care unit (ICU) patients with coronavirus disease 2019 (COVID-19) and severe hypoxaemia. Methods We conducted pre-planned analyses of one-year mortality and health-related quality of life (HRQoL) in the Handling Oxygenation Targets in COVID-19 trial. The trial randomised 726 ICU patients with COVID-19 and hypoxaemia to partial pressure of arterial oxygen targets of 8 kPa (60 mmHg) versus 12 kPa (90 mmHg) during ICU stay up to 90 days, including readmissions. HRQoL was assessed using EuroQol visual analogue scale (EQ-VAS) and 5-level 5-dimension questionnaire (EQ-5D-5L). Outcomes were analysed in the intention-to-treat population. Non-survivors were assigned the worst possible score (zero), and multiple imputation was applied for missing EQ-VAS values. Results We obtained one-year vital status for 691/726 (95.2%) of patients and HRQoL data for 642/726 (88.4%). At one year, 117/348 (33.6%) of patients in the lower-oxygenation group had died compared to 134/343 (39.1%) in the higher-oxygenation group (adjusted risk ratio: 0.85; 98.6% confidence interval (CI) 0.66–1.09; p  = 0.11). Median EQ-VAS was 50 (interquartile range, 0–80) versus 40 (0–75) (adjusted mean difference: 4.8; 98.6% CI  − 2.2 to 11.9; p  = 0.09) and EQ-5D-5L index values were 0.61 (0–0.81) in the lower-oxygenation group versus 0.43 (0–0.79) ( p  = 0.20) in the higher-oxygenation group, respectively. Conclusion Among adult ICU patients with COVID-19 and severe hypoxaemia, one-year mortality results were most compatible with benefit of the lower oxygenation target, which did not appear to result in more survivors with poor quality of life.